Chronic Pain – Nature and Nurture
Does chronic pain have a genetic or environmental basis? It often seems as though we treat whole families of chronic pain patients, including spouses, step-relatives, and adopted children, as well as genetically related family members. New research may indicate that there is a genetic AND environmental component.
It has been well-documented that children of parents with chronic pain are at increased risk of developing chronic pain themselves. What is not known is the mechanism(s) by which this increased risk is conferred. McIntosh et al used statistical analysis of data from Generation Scotland: Scottish Family Health Study, UK Biobank and Pfizer23andMe, to determine that the “heritability of chronic pain is substantial, accounting for 38.4% … of the variation” in chronic pain scores, and “shared environment with a spouse [with chronic pain or depression] accounted for approximately 18.7% … of the variation”. Previous studies have reported heritability of chronic pain at 30% to 66%. There is also an association between genetic risk for depression and the development of chronic pain, independent of the development of frank depression, although, interestingly, the converse was not found.
The study does not elucidate specific genetic markers for chronic pain, but it does indicate that it is a polygenic phenomenon. The study also does not draw conclusions about the nature of the environmental effect. Possible mechanisms include diet, infectious disease history, or other mechanisms, as well as preferential bonding/mating.
If the genetic and environmental contributors to the development of chronic pain can be teased out, it may be possible to develop new interventions and medication targets to prevent chronic pain, and to treat it more effectively. In the meantime, awareness of the genetic and environmental components may help identify patients at risk of developing chronic pain.
- McIntosh AM, Hall LS, Zeng Y, et al. Genetic and environmental risk for chronic pain and the contribution of risk variants for Major Depressive Disorder: A family-based mixed model analysis. PLOS Medicine, 2016; 13(8).
- Stone AL, Wilson AC. Transmission of risk from parents with chronic pain to offspring. PAIN, 2016.
At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.